TKR My second TKR recovery begins

[New England Librarian]

I am one day past my right TKR, and 11 years past my left TKR. I am very happy to have had the same wonderful surgeon, but so many other things have changed in those 11 years!

I had to get care team permission (for various medical reasons) to stay over one night (a “23 hour” stay), while 11 years ago I was an inpatient for 3 nights. I had spinal anesthesia instead of general, but also something to make me sleep. I have been told that the incision is much smaller than before, the muscles were pulled aside instead of cut, and the nerve block covers a smaller area.

Most promising is that I tried the new non-opiate pain medication Journavx, and it seems to be working! I can take it with the opiate if needed, but need a smaller opiate dose. I am optimistic that this will remain true as the nerve block continues wear off. Fingers crossed!

 

[benne68]

Welcome to the healing side, @New England Librarian! We're glad you are here so we can support you on your recovery journey.

Even though you've been through a TKR before, it's been quite a few years so you may need a refresher on BoneSmart's Knee Recovery Guidelines. Each article is short, but informative. Following these guidelines will help you have a less painful recovery.

Just keep in mind we are all different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.” Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

Also, remember that every knee is different -- even 2 knees in the same person!

KNEE RECOVERY GUIDELINES
(Note to Basic Members: The links below are a premium service available only to Insiders Club Members. To learn about membership, click here ).

1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary.

2. Control discomfort:
rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork your new knee.

3. Do what you want to do BUT
If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you.
If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.

4. Good Nutrition is essential for successful recovery:
Dietary Tips for Recovery
Nutrition Basics

4. PT or exercise can be useful BUT take note of these
BoneSmart view on exercise
BoneSmart philosophy for sensible post op therapy
and please also read the Recovery myths below.

5. At week 4 and after you should follow this
Activity progression for TKRs

7. If you want something to assist with incision healing and scar management, BoneSmart recommends hypochlorous solution. Members in the US can purchase ACTIVE Antimicrobial Hydrogel through BoneSmart at a discount. Similar products should be available in the UK and other countries.

8. Still need recovery aids? The BoneSmart Recovery Shop offers BoneSmarties best-loved recovery products at great prices.

Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?
Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

Recovery myths:
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds


We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery. While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.

 

[sistersinhim]

It is amazing how much things have improved in the last 11 years. I had mine 10 years ago, and would not be nearly as afraid if I had to have the old knee replaced now because of these improvements. With these improvements, you still must be careful with your recovery and to not overdo too soon. That causes setbacks and added inflammation, pain, and swelling. We have found that it's best to be gentle with your new knee for at least a couple of months before beginning more aggressive exercises. Many find that they don't even need PT at all, that their daily activites are enough to recover nicely. I am one of those.

 

[Layla]

Hello and Welcome!
Thanks for joining us and congrats on your new knee! It sounds like you're off to a good start. I look forward to following your healing journey.

New England is beautiful this time of year, enjoy the spectacular display of color.
Best Wishes!
@New England Librarian

 

[benne68]

I tried the new non-opiate pain medication Journavx, and it seems to be working! I can take it with the opiate if needed, but need a smaller opiate dose. I am optimistic that this will remain true as the nerve block continues wear off.

Yes, quite a few surgeons are prescribing Journavx now, based on reports from other members, it really does make a difference. You might still need an opioid for a day or two when the nerve block wears off, but most members say they only need it for occasional breakthrough pain.

Keep us posted!

 

[New England Librarian]

Starting Day 5 after right TKR on October 8. The Journavx is still helping, but I am also taking an opiate as needed - and most days it is needed! Experiencing very strong loss of appetite, but not actual nausea. My surgeon strongly recommended that I rent a combination “waterless” ice and compression machine (brand name “NICE”), and this thing is a game changer. The coolant doesn’t require actual ice, and doesn’t need to be changed, and there are multiple coldness and compression settings. It will cycle on and off endlessly - for instance, I can use a coldness setting of 3 (out of 6) and low intermittent compression for 20 minutes, then 20 minutes off, all night or day. I truly believe that I have less swelling and bruising than last time, and it’s possible I am moving better, although it’s still early. On the other hand, it’s costly, even as a one-month rental, and it’s quite heavy and bulky to move from room to room. But so far I’d recommend it.

 

[Legseleven]

You’re doing great. Cold compression helps so much. Keep taking the meds as you need them. It’s a marathon not a sprint as you will remember, although meds and technology have improved in 11 years, and having done it once you know you can do it again.
Please keep us updated and have a good day.

 

[Layla]

Hi New England Librarian,
Glad you're able to control the ups and downs with the pain well enough in these early days.

Loss of appetite is common. Do stay hydrated though and try to concentrate on getting enough protein which is so important as you're healing. A few ideas you can try as snacks if full meals sound unappealing right now.
Nuts
Trail Mix, Pumpkin Seeds, Hemp Seeds
Greek Yogurt, Cottage Cheese, Sliced Cheese
Hard Boiled Eggs
Tuna (if you eat fish)
Canned Salmon on Crackers (if you eat fish)
Veggies & Hummus
Peanut Butter and Apple, or PB and Celery
Protein Bars or Shakes or No Bake Energy Bites (many online recipes)
Edamame, Lentils, Chickpeas

I hope today is a good day! Thanks for sharing an update with us.
Following is a link to some Dietary Tips in case you haven't read it yet - Dietary Tips
@New England Librarian

 

[benne68]

The coolant doesn’t require actual ice, and doesn’t need to be changed, and there are multiple coldness and compression settings.

I rented one of these for my 2nd TKR and agree with you that it's a game-changer not having to worry about refilling ice. It is expensive to keep renewing the rental -- but I thought the benefits outweighed the cost.

I noticed significantly less swelling (and also less bruising) on the knee.

Hope it continues to help you!

 

[New England Librarian]

End of Day 6, and I am feeling that my progress is faster than last time. The Journavx is still helping, and I am taking less narcotic doses than last time. Swelling has peaked, I hope: the bruising and swelling are all at the top inside of my right (operative) thigh, which currently measures 2” bigger in circumference than my left (non-operative) upper thigh. It’s unattractive and uncomfortable, but I assume it’s all normal. I wonder if the cold/compression machine might be pushing all the swelling upwards? My first post-op visit is with my surgeon’s PA in 6 days, and the dressing comes off tomorrow. Showers have been lovely, friends have been generous with visits, food and errands, and home PT visits have been helpful and encouraging! I think that knowing what to expect has made a big difference this time around.

 

[Legseleven]

Thank you for updating us. I’m glad the new medicine is helping, unfortunately it’s not yet available in the UK.
The compression and ice machine should apply consistent pressure but not too much, and it should not lead to swelling in another part of the leg. Bruising takes about 2 weeks to disperse.
Did you ask the Home PT about the swelling when they visited?
Have you tried icing and elevating the swollen part of the thigh?
This information on elevation may be useful. What are you using to elevate? Have you a Lounge Doctor?
Keep us posted and have a good day.

 

[Layla]

Happy One Week Anniversary!
I remember setting one week post op as my first goal. So much for lofty goals, lol.
It felt like a lot changed quickly in that minuscule amount of time considering how long recovery can be. Thanks for sharing your progress, NEL.

Glad the meds are helping and you're needing less than last time. Swelling and bruising beyond your knee can certainly be normal. It can show up or down your leg. I didn't have any bruising show up after my joint replacement until faded bruising surfaced 17 days post op. Take care to use the compression sleeve as instructed and make sure it's not excessively tight. The visiting PT should be able to assess your swelling and bruising as they're certainly familiar through experience, so please do ask for the reassurance I'm sure you'll receive.

Best wishes for your first post op visit! If we don't hear from you before then, let us know how the appointment goes.
@New England Librarian

 

[New England Librarian]

Thank you! Yes, my bruising and swelling were both deemed normal, and will eventually subside. Home PT was more vigorous today, including partial turns on a foot pedal apparatus, extension work, and lots of gentle, gradual bending. It hurts like heck tonight!

I have one more home PT session early next week, then may be discharged to outpatient. Before surgery, I had been hearing from friends that many local PT practices were very busy, so I made my outpatient appointments several weeks ago, and I’m glad I did. They were very willing to be flexible about the start date, depending on my readiness, but I might have faced a gap in my care if I had waited until after surgery to book those appointments.

The outer bandage came off today, which felt good, and my first post-op appointment is next week, when the steri-strips (and whatever is under them!) may be removed.

I’m still in a fog, and not always sure what day it is, probably due to both the anesthesia and the pain meds. It can be amusing, and embarrassing, and I’m glad I am not trying to work or run a large household during this time! Thanks for the support and knowledge.

 

[Legseleven]

Home PT was more vigorous today, including partial turns on a foot pedal apparatus, extension work, and lots of gentle, gradual bending. It hurts like heck tonight!

I had to read this several times to actually believe it. I am so sorry you’ve experienced this. You are only 8 days post op. Your knee has gone through a major trauma. Your only job in the first two weeks is to rest and recover from the op while icing and elevating and moving around every hour in the day time. The brain fog is normal, it’s all the meds from the op and since.
Please consider stopping what sounds like quite aggressive PT. It’s much too soon to be pedalling. A few quad sets and heel slides, and calf raises are all that’s needed on top of walking about the house and trips to the bathroom.
The Bonesmart way is never to force anything, and never to cause pain. Please do go back to post #2 in this thread and catch up with the articles and guides which benne68 posted for you. This chart may also help explain things a little more.
And I’ll ask @benne68 to find and post the article which evidences the less is more approach. I can’t find it right now.
I hope the pain eases, Day 8 this time was my most painful day and I was just moving about a bit. And truly PT was the last thing on my mind until the knee was more comfortable and settling.

 

[Layla]

Hi New England Librarian, I believe the article, Legseleven was referencing is below in blue -
Patients Find a Quiet Approach Is Better Than Aggressive PT

I made my outpatient appointments several weeks ago, and I’m glad I did. They were very willing to be flexible about the start date, depending on my readiness, but I might have faced a gap in my care if I had waited until after surgery to book those appointments.

I do hope you're not in the ODIC today after what sounds like an aggressive PT session yesterday. A gap in your care may have been the best medicine since in the early days you don't need to be doing much. Obviously the choice is yours, but we caution a slow and easy approach in the first few weeks works best. As an example -

Week 1 Post Total Knee Replacement​

Focus on short walks within the home, at least every hour or two that you're awake, such as trips to the bathroom or kitchen. Avoid activities like cooking or housework at this stage. Continue with ankle pumps and gentle knee bends to promote circulation and help prevent blood clots. Prioritize rest, ice, and keep the leg elevated as much as possible to support healing.
In addition to the activities from Week 1, begin incorporating short walks around the home 3-4 times per day, aiming for approximately five minutes each. The goal is to build endurance gradually. Avoid pushing through pain or fatigue. Stop and rest before reaching the point of discomfort, or exhaustion.

Week 2​

In addition to the activities from Week 1, begin incorporating short walks around the home 3-4 times per day, aiming for approximately five minutes each. The goal is to build endurance gradually. Avoid pushing through pain or fatigue. Stop and rest before reaching the point of discomfort, or exhaustion.

I felt mentally cloudy for a couple weeks myself post op. Couldn't absorb reading the Recovery Guidelines, nor recall if I asked someone a question, or received an answer, which was a bit unnerving to me. Thankfully it wore off as your mental sluggishness will also. It can be due to the anesthesia and meds as you noted. If you're not getting enough sleep, that can contribute as well as not drinking or eating enough. So stay hydrated and eat some protein snacks throughout the day if your appetite isn't back to normal.
I hope you have a peaceful relaxing weekend!

 

[EalingGran]

Home PT was more vigorous today, including partial turns on a foot pedal apparatus, extension work, and lots of gentle, gradual bending. It hurts like heck tonight!

Agree with @Legseleven and @Layla that vigorous PT so early is both unnecessary and potentially counterproductive. It really should not hurt and if something hurts you should definitely stop doing it.
I just did my own exercises from the booklet I was given by the hospital plus some private sessions with my excellent pilates teacher- who adopts a gentle holistic approach. I never pushed past pain. I have really great ROM which is almost as good as my unoperated side. Take it easy at this early stage.

 

[New England Librarian]

Thank you all for your advice! Yesterday’s PT wasn’t actually as active as I made it sound, more of a preview of what will be coming in the next weeks. But today I had no activities and spent most of the day elevating, icing and napping! I try to remember to do the ankle flexes, and the quad and glute sets, whenever I can. Calf raises and heel slides are still difficult, but getting better. I have been able to cut way back on the pain medication, and finding that Tylenol is working pretty well during the day. My post-op visit is on Tuesday, which will be my first outing. I still feel that it’s going better with knee #2 than knee #1, probably mostly because I know what to expect, but also because of newer medications and surgery advances.

 

[Layla]

Good Afternoon NEL,
I am glad to hear that we may have misjudged your PT session. If it's a preview of what's to come, I trust you'll use your stern voice if it feels unreasonably uncomfortable or painful. We don't want to see you sidelined in the ODIC. No fun!

You're making good progress with the meds and how wonderful that this second recovery feels like less of a challenge. It's better than the other way around!

Best wishes for your maiden voyage back out into the world on Tuesday.
I hope you have a great appointment with the reassurance you're doing very well. Happy Saturday!
@New England Librarian

 

[sistersinhim]

Home PT was more vigorous today, including partial turns on a foot pedal apparatus, extension work, and lots of gentle, gradual bending. It hurts like heck tonight!

Nighttime pain is normally caused by doing too much during the day. This coinsides with you PT appointment earlier that day. Be a strong advocate for your knee and insist on gentle movements only in these first few months. Many never even take any PT after a knee replacement and recovered just fine. I didn't take any and will not for any future joint replacements either. I firmly believe our bodies know how to heal themselves without have someone tell it how it!

 

[Jockette]

I firmly believe our bodies know how to heal themselves without have someone tell it how it!

When my grandson was 2, he fell while playing and broke his leg. He had a cast for about 6 weeks. After it came off, no one recommended PT. He used his leg as he could, stopping if something hurt, and trying again at another time. He recovered just fine. If a 2 year old can be trusted to “rehab” his own leg, surely we adults can do it.